Intrauterine fetal demise as a result of maternal COVID-19 infection in the third trimester of pregnancy: A case report

Abstract

Introduction: As the global pandemic continues, more information is being collected on the incidence and range of adverse maternal and fetal outcomes resulting from COVID-19 infection.

Presentation of case: We present a case of a 29-year-old unvaccinated patient at 36 weeks gestation with several days of mild symptoms after testing positive for COVID-19 who presented with a complaint of decreased fetal movement and was found to have an intrauterine fetal demise. This case was further notable for thrombocytopenia, acute postpartum hemorrhage and placental histologic findings showing morphologic changes consistent with previously reported pathology seen with maternal COVID-19 infection including marked perivillous fibrin deposition and marked acute and chronic intervillositis.

Discussion: This case, combined with other similar reports in the literature, supports the conclusion that COVID-19 infection in pregnancy can result in severe perinatal adverse consequences regardless of initial maternal symptomatology.

Conclusion: Pregnancies affected by COVID-19 may benefit from a higher level of surveillance and proactive care and further research is warranted.

Keywords: COVID-19; Infection; Intervillousitis; Placenta; Placentitis.

Fig. 1

Gross examination of placenta A. Material surface of placenta. B Fetal surface of placenta.

Fig. 2

Microscopic examination of placenta. A. Low power view of intervillous space with perivillious fibrin deposition, intervillositis, and trophoblast necrosis (H&E, 100×). B. High power view of intervillous space with abundant lymphocytes, histiocytes and neutrophils (H&E, 400×). C. Strongly positive SARS-CoV2 in situ hybridization (ISH) stain in villous trophoblasts (H&E, 100×).